Healthcare Provider Details

I. General information

NPI: 1003854746
Provider Name (Legal Business Name): JOAN P. CARDIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W MAIN ST
HOMER LA
71040-3328
US

IV. Provider business mailing address

912 W MAIN ST
HOMER LA
71040-3328
US

V. Phone/Fax

Practice location:
  • Phone: 318-927-3571
  • Fax: 318-927-2677
Mailing address:
  • Phone: 318-927-3571
  • Fax: 318-927-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP02203
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAP02203
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: